A few days after this issue hits our desks, we'll huddle in the conference room for our issue critique, a monthly conclave for us editors to tell each other what was good, bad and ugly about the issue. It's best to check your ego at the door and slip on a bulletproof vest, as the slings and arrows can fly fast and furious - especially if a headline you wrote, an article you edited or a modifier you dangled is standing before the firing squad. To be sure, the criticisms outnumber the compliments, but it's a constructive, collegial and courteous exercise aimed at helping us publish a better magazine and forcing us to think like readers, not editors. We once called them slash sessions, but thought issue critique wouldn't hurt as much.

We assign each editor a few departments and features. The mission: Get out your red pen and find three things that work and three things that need work. Let me show you how it would be for the final changes to Medicare's ASC list that CMS released on April 29. As you know, the ASC list identifies the procedures that Medicare will pay ASCs for providing. What's on and not on the list can make or break many freestanding centers.

Three things that work

• CMS will delete only five procedures from the ASC list, which is 95 fewer than first proposed.
• CMS will add 65 procedures (40 more than first proposed) to the 2,464 procedures on the ASC list, including bronchoscopies and selected endoscopies.
• CMS acknowledged that it carefully considered the arguments and clinical evidence submitted by physicians, ASCs, professional and trade associations and medical societies and organizations in changing the regulations, which take effect July 5.

Three things that need work

• CMS should eliminate the ASC procedures list and instead adopt an exclusionary list, specifying what is not reimbursed.
• CMS should add to the list laparoscopic cholecystectomies, which have been performed in ASCs since the procedure was first introduced.
• CMS should scrap its comparatively crude ASC fee schedule, which has only nine payment rates for about 2,500 different surgical procedures. The basic structure of the rates has not been updated since 1990. A better alternative is an ASC payment system that links ASC facility fees to the payments made to HOPDs for the same surgical procedures.

On The Web
Go to writeOutLink("www.cms.hhs.gov/suppliers/asc/1478_42805.pdf",1) to download CMS's final deletions and additions to the list of Medicare-approved ambulatory surgical center procedures.